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VOL. 27, NO. 33, May 02, 2008 (Baishakh 20 2065 B.S.)
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Mosquito Menace
Malaria has returned with a bang threatening the lives of people, especially in rural areas
By A Correspondent
A couple of days before the International Malaria Awareness Day (April 25), around a dozen patients had come to district hospital in Gulariya, Bardia - 500 kilometers west of capital Kathmandu – complaining high fever.
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Rural population: Are they aware? |
Following the blood test, they were found to have been infected by Malaria. As usual, they were given anti-malaria drugs and asked to come again for follow-up. This was a normal practice in Nepal about treating a patient who is diagnosed with malaria.
Most of the infected persons are infected by parasitic protozoans called Plasmodium vivax, considered less dangerous than the P. falciparum. According to Epidemiology and Disease Control Division, altogether 12 districts including Bardiya are riskier in terms of malaria infection susceptibility.
Along with medicines, the district health officials also recommend Indoor Residual Spraying in these areas. This process of administering medicines and spraying toxin to kill the Anopheles species of mosquito (which carries the parasite) has been practiced for last 50 years but it failed to protect the people.
Although the studies have shown that sleeping under insecticide-treated bed nets (ITNs) can reduce mortality by up to 63 percent, Nepal is yet to be in a position to distribute such nets to all the population living in areas vulnerable to malarial infection.
In many parts of the country, economically poor people sleep out in the open and find it uncomfortable to sleep under the net. For successful use of bed nets, there is a need for a behavioral change.
Nepal has set up health institutions in many rural parts but they still lack basic facilities like test-labs and materials.
As temperature rises and monsoon approaches, the patients visiting health posts with high fever continues to rise not only in Bardiya district but also in other districts lying on the southern plain.
"Nearly 120 people have been diagnosed with malaria in the last 10 months in Bardiya district and 11 patients were suffering from fatal malaria caused by plasmodium falciparum," said Dr. Guna Raj Lohani, a medical superintendent. "Hundred and five other patients are suffering from malaria caused by less dangerous plasmodium vivax."
Not only the plain areas, even hilly district like Ilam has reported infection related to malaria in recent years. According to District Public Health Office, Ilam, 69 persons were affected by Malaria last year.
The first attempt to control Malaria in Nepal was initiated in 1954 through the Insect Borne Disease Control Program supported by USAID.
In 1958, the malaria eradication program in the country was launched with the objective of eradicating malaria from the country within the limited time period. However, the program was converted into a malaria control program in 1978.
Currently, malaria control service is being provided free of cost to approximately 17.3 million people of 65 districts at risk of malaria. Out of Nepal's total population, approximately 74 percent are at risk.
According to Department of Health Services, High Malaria Incidence has been observed even in hilly and mountainous districts such as Kavre, Sindhupalchowk, Bhojpur and Dhankuta districts along with in terai districts like Kanchanpur and Bardiya.
Despite increasing number of health facilities in rural parts of Nepal, a large number of malaria patients suffer undetected .
According to Department of Health Services, annually Indoor Residual Spraying off was carried out in outbreak areas, and new settlements in high risk malaria areas. The health officials closely observe the prevalence of P. falciparum cases and areas with drug resistant malaria.
With the virtual eradication in early 1970s, the Malaria has again come back stronger and resistant to drugs threatening a large number of population living in various parts of Nepal. From plain to mid-hill and mountains, Malaria is now everywhere.
As the temperature is rising globally thanks to the global warming, the situation may go from bad to worse in coming days. The disease-carrying mosquitoes are now flying even to Himalayan regions taking advantage of rising temperature.
"There are some regions where people need to be alert as the season for the disease approaches. Generally, the monsoon season beginning from June to September is a period of high prevalence," said Dr. Manas Kumar Banerjee, Malaria expert and coordinator of Avian Influenza Project, speaking at a press conference organized on the eve of World Malaria Day.
Another health expert warns that mosquitoes are attacking the people all over the country. "Only 10 out of 75 districts in the country are safe from the risk of malaria. Though 65 districts are at risk, the government has focused on 13 districts from where most cases of diseases are being reported," said Dr G.D. Thakur, chief of Disease Control Division.
Unlike in the past, much of the latest technology is now available to fight Malaria. "The people should be made aware of latest technology to prevent themselves from the disease," said Dr. Banerjee.
Net Against Mosquitoes
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A woman from Terai region: Vulnerable |
As the people living under poverty line are more vulnerable to the disease, the government is now planning to supply nets free of cost to those areas where people cannot afford.
The government distributed 340,000 nets last year. Of the total recipients, 85 percent received them for free while 14 percent were charged Rs 150 each. "One net per family was distributed and they were suggested to prioritize children and women to sleep inside the net as they are at higher risk," said Dr. Thakur.
This year the government is planning to distribute 200,000 more nets which would be absolutely free and one net per two people would be distributed. Although the net has proved to be one of the most effective ways to control the disease worldwide, it is yet to be seen how effective the net distribution will be in Nepal.
Controlling malaria is one of the greatest challenges for the country. As many Nepalis go to work in Malari-infested areas of India like in northeast, they carry the malaria with them. The global warming and import of malaria from India has remained a great challenge in controlling malaria in the country. In 2007, 4220 positive cases of malaria were tested.
According to World Health Organization, malaria is the eighth highest disease burden worldwide and the fifth-highest for the poorest developing countries. This mosquito-borne disease disproportionately afflicts and kills children under 5 and pregnant women. Sleeping under insecticide-treated bed nets can reduce mortality by up to 63 percent and morbidity by at least 40 percent.
Under the Global Fund for AIDS, Tuberculosis and Malaria, the net is distributed to the affected population. "Along with free distribution of net, we are also encouraging local population to contribute small amount of money to buy it," said Dr. Thakur.
Malaria was Nepal's most serious public health problem in the past afflicting roughly 25 percent of the population in 1950s. Endemic malaria threatened roughly 50 percent of Nepal's population living below 1300 meters of altitude and now it is expanding its area of infection.
At a time when the temperature of the earth is rising due to the global warming, Malaria is going to be a major challenge of public health in coming days. Bardiya's cases remind the urgency of the need to tackle it.
